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<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Register</title>
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<body>
<table width="553" border="0" align="center" cellpadding="0" cellspacing="0">
  <tr>
    <td width="553" bgcolor="#999999"><p align="center"><span class="style22">Buat Akun Baru</span></p>
        <form action="proses.php" method="post" enctype="multipart/form-data" name="form1" id="form1">
          <table width="0" border="0" align="center" cellpadding="5" cellspacing="2">
            <tr>
              <td><span class="style23">Nama Depan</span></td>
              <td><span class="style30">:</span></td>
              <td><label>
                <input name="nama_depan" type="text" id="nama_depan" size="35" />
              </label></td>
             
            </tr>
            <tr>
              <td><span class="style23">Nama Belakang</span></td>
              <td><span class="style30">:</span></td>
              <td><label>
                <input name="nama_belakang" type="text" id="nama_belakang" size="35" />
              </label></td>
             
            </tr>
            <tr>
              <td><span class="style23">Alamat</span></td>
              <td><span class="style30">:</span></td>
              <td><textarea name="alamat" cols="35" id="alamat"></textarea></td>
              
            </tr>
            <tr>
            <td><span class="style23">Nomer Telepon</span></td>
              <td><span class="style30">:</span></td>
              <td><input name="notelp" type="text" id="notelp" size="35"/></td>
              
            </tr>
            <tr>
             <td><span class="style23">E-mail</span></td>
              <td><span class="style30">:</span></td>
              <td><label>
                <input name="email" type="text" id="email" size="35" />
              </label></td>
             
            </tr>
            <tr>
            <td height="27"></td>
              <td></td>
              <td></td>
             
            </tr>
            <tr>
              <td><span class="style23">Nama Depan Anak</span></td>
              <td><span class="style30">:</span></td>
              <td><input name="nama_depan_anak" type="text" id="nama_depan_anak" size="35" /></td>
             
            </tr>
            <tr>
              <td><span class="style23">Nama Belakang Anak</span></td>
              <td><span class="style30">:</span></td>
              <td><input name="nama_belakang_anak" type="text" id="nama_belakang_anak" size="35" /></td>
             
            </tr>
            <tr>
              <td><span class="style23">Jenis Kelamin Anak</span></td>
              <td><span class="style30">:</span></td>
              <td class="style28"><input type="radio" name="jk" id="radio3" value="1" />
              Laki-laki</td>
              </tr>
              <tr>
              <td></td>
              <td></td>
              <td class="style28"><input type="radio" name="jk" id="radio4" value="2" />
              Perempuan</td>
            </tr>
            <tr>
              <td>&nbsp;</td>
              <td>&nbsp;</td>
              <td><span class="style28">Kota</span></td>
              
            </tr>
            <tr>
              <td><span class="style23">Tempat Tanggal Lahir Anak</span></td>
              <td><span class="style30">:</span></td>
              <td><input name="kota" type="text" id="kota" size="35" /></td>
              </tr>
              <tr>
              <td></td><td></td>
              <td><span class="style28">Format:(yyy-mm-dd)</span></td>
              
            </tr>
            <tr>
            <td></td>
              <td></td>
              <td><input name="tanggal_anak" type="text" id="tanggal_anak" size="35" /></td>
              
            </tr>
            <tr>
            <td></td>
              <td></td>
              <td></td>
            </tr>
            <tr>
            <td height="24"></td><td></td><td></td>
            </tr>
             <td width="198"><span class="style23">User Name</span></td>
              <td width="8"><span class="style30">:</span></td>
              <td width="228"><label>
                <input name="usename" type="text" id="usename" size="35" />
              </label></td>
              
            </tr>
            <tr>
            <td><span class="style23">Password</span></td>
              <td><span class="style30">:</span></td>
              <td><label>
              <input name="password" type="password" id="password" size="35" />
              </label></td>
              
            </tr>
            <tr>
             <td><span class="style23">Verifikasi Password</span></td>
              <td><span class="style30">:</span></td>
              <td><label>
                <input name="password2" type="password" id="password2" size="35" />
              </label></td>
              
            </tr>
            <tr>
            <td></td>
              <td></td>
              <td></td>
              
            </tr>
            <tr>
              <td>&nbsp;</td>
              <td>&nbsp;</td>
              
              </tr>
              <tr>
              <td><blockquote>
                <blockquote>
                  <p>
                    <input type="submit" name="Save" id="Save" value="Save" />
                  </p>
                </blockquote>
              </blockquote></td>
              <td></td>
              <td><blockquote>
                <blockquote>
                  <p>
                    <input type="reset" name="cancel" id="cancel" value="Cancel" />
                  </p>
                </blockquote>
              </blockquote></td>
              
          </table>
</form>
        </td>
  </tr>
</table>
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